PSORIASIS dermatology slideshow by students

Good

1. PSORIASIS PRESENTED BY: AIMAN REHAN NAVERA MUKHTAR MARYAM ZAHOOR 4 TH YEAR MBBS KMDC

2. S LEARNING OBJECTIVES Introduction Etiology Different Types of Psoriasis Treatment/ Management

3. PSORIASIS “Chronic inflammatory skin disease characterize by well-defined erythematous, silver scaly plaques affecting extensor surfaces”. (Its elbow & knee) Sites : scalp , extensors surface, axilla (skinfolds), trunk & nails. SIGN &SYMPTOMS Scaling.. most common symptom. Itching Erythema tightness of skin

4. ETIOLOGY Genetic: One third family history. Concordance rate in monozygotic PROVOCATIVE FACTORS: INFECTION SUNLIGHT TRAUMA ENDOCRINE PREGNANCY 30%IMPROVEMENT. 18% WORSENING. STRESS DRUGS LITHIUM ANTIMALARIAL. B BLOCKERS ACE INHIBITORS LIFE STYLES (SMOKING AND ALCOHOL)

5. PATHOPHYSIOLOGY : Psoriasis autoimmune is a T-cell mediated disease. Unknown skin antigen stimulate: immune response leads activation of antigen-specific memory T-cells; which are primary mediator of psoriasis. → leads to impaired differentiation and hyper-proliferation of keratinocytes. The transit time for keratinocyte migration from basal layer to stratum corneum is usually 23 days .its reduces to 5 days - premature cells appear on stratum corneum. AUSPITZ SIGN ( appearance of small bleeding points after removal of layers of scale from psoriatic plaques surface. )

6. PATHOGENESIS: Genetic Background ¯ Provocation Factors ¯ Exogenous/Endogenous antigens ¯ Antigen presentation by APCs ¯ T lymphocyte- mediated Immune response ¯ Secretion of cytokines ¯ Inflammation & cellular hyper proliferation ¯ Clinical Lesions of psoriasis

7. TYPE OF PSORIASIS Chronic Plaque Psoriasis Nail Psoriasis Flexural Psoriasis Guttate Psoriasis Pustular Psoriasis Erythrodermic Psoriasis Psoriatic Arthritis

8. CHRONIC PLAQUE PSORIASIS Most common Psoriasis. More stable disease, Typical lesion Raised, well-demarcated, erythematous plaque of variable size, covered white, silvery scales. Mostly on extensor surfaces (knees, elbow), scalp and lower back. In the body it can present as Scalp Psoriasis: Erythematous scaly plaque that travels with hairline

9. NAIL PSORIASIS Nail Psoriasis can take several forms: Nail pitting Onycholysis Subungal Hyperkeratosis Beau's Line Splinter hemorrhages

10. FLEXURAL PSORIASIS Well-defined erythematous area in axila , groin, beneath breast and other skin folds. Scaling is absent, hence needs to be differentiated from tinea. Also called Inverse Psoriasis

11. GUTTATE PSORIASIS C haracterize by widespread small plaques scattered on trunk & limbs. Involve children + Adolescent History of sore throat (B-hemolytic Upper Resp. Tract Infection. Streptococcus) Lesion is Pink with less scaling

12. Localized Form: Confined To Hands And Feet . Chronic Course. Very Resistant To Treatment. Generalized Form: Involves Whole Body. PUSTULAR PSORIASIS

13. ERYTHRODERMIC PSORIASIS Medical emergency condition Generalized erythema covering. All skin. Complication: cardiac failure dehydration hypothermia· It usually result from withdrawl of systemic steroids. Excess alcohol, lithium

14. PSORIASIS PALMS AND SOLES May present as typical plaques. Less well defined plaques may resemble lichen simplex or hyperkeratotic eczema

15. PSORIATIC ARTHRITIS It has 5 Patterns: DIP joint involvement. Symmetric polyarthritis Arthritis mutilans (telescoping of fingers) Spondylitis Asymmetrical oligoarthritis (sausage shaped digits )

16. TREATMENT Topical Treatment Systemic Therapy

17. TOPICAL TREATMENT 1. Emoliants Cream: It hydrate the skin 2. Keratolytics : Scrap off the skin crusting Soften and lift the psoriatic skin. Include salicylic acid and urea 3. CoalTar : Reduce inflammation and pruritis 4. Dithranol : Anti proliferative agent Can burn skin so not suitable for face and genitals Effective for thick plaque psoriasis 5. Tazarotene : Topical Synthetic Retinoids For Treatment Of Chronic Plaque Psoriasis Anti Proliferative And Anti Inflammatory Synthetic Vit D Use For Chronic Plaque Psoriasis 6. Phototherapy: Done in psoriasis resistant to topical treatment Has immunomodulatory and anti inflammatory effect Has 3 main types i ) Broad band UVB ii) Narrow band UVB iii) PUVA (Psoralen ultraviolet A )

18. SYSTEMIC THERAPY 1.Methotrexate: Most common drug Cause immunosuppression and reduce cell proliferation 2.Cyclosporin: Immunosuppressive agent 3.Acretin: Oral retinoid For severe psoriasis Teratogenic 4. Biological Agent Expensive TNF alpha and IL inhibitor

19. THANK YOU !!